These comments are responses
to the questions listed below,
which were generated in regard to the Steve Dahl / Patrick Pechacek
Interview of
10- 01-10..

The Questions:

Today's discussion
covers a Civic Caucus meeting with Steve Dahl and Patrick Pechacek,
directors, Deloitte Consulting. Under a plan prepared by Deloitte,
Minnesota state employees choose health care providers based on four
different levels of pricing. The plan produced insurance premium
savings to the state of 10 percent in the first year, 2002, and more
savings in subsequent years.

Response Summary:
Readers have been asked to rate, on a scale of (0) most disagreement,
to (5) neutral, to (10) most agreement, the following points discussed
by Dahl and Pechacek. Average
response ratings shown below are simply the mean of all readers’
zero-to-ten responses to the ideas proposed and should not be
considered an accurate reflection of a scientifically structured poll.

1. Health care
prices
(8.3 average response) Quality of health
care is not necessarily related to prices charged by providers. Higher
quality care might well be offered by providers whose prices are lower
than average.

3. Other public
plans
(8.5 average response) Minnesota ought
to broaden the use of a tiered system of health care premiums--now
limited to state government employees--to other public employees in
the state and to others for whom the state pays or provides health
care.

3.
Other public plans. Hard to implement in government programs because
the enrollees are responsible for so little of their premium. An
alternative model might offer incentives (e.g. a Target gift card) for
choosing providers in the lowest tier.

Ray Ayotte (10) (10) (10) (10)

Ken Smart (10) (10) (10) (10)

3.
Other public plans. Long term, the full cost of health insurance
should be paid by the employees rather than by the government with a
corresponding tax deduction allowed for the cost of such insurance.
But even then, it makes sense for the state to offer a tiered system
of health care premiums.

4.
Private plans. Private employees should also pay for their own health
insurance with a corresponding tax deduction. Perhaps this is where
the state could partner with businesses and allow businesses access to
the same tiered providers at same or similar cost. Business
participation would be voluntary. There should also be a high
deductible, consumer-driven, Health Savings Account (HSA) option made
available.

Mike Weber (10) (10) (10) (10)

1.
Health care prices. Every incentive should be built into preventative
care and all providers should be morally responsible for providing
quality care rather than quantity services that many times are not
needed.

2.
Price-sensitive choices. Health care cost could be immediately
reduced if people needing medical service would be required to co-pay
for service and be given factual information about actual cost of
those services. In the health care bill if they published information
about cost versus quality of service there would be a huge cost
savings for consumers but of course it would be bucking the bottom
line of providers and insurance carriers’ profits.

3.
Other public plans. By broadening it would help every consumer of
health care.

Peter Hennessey (7.5) (7.5) (2.5) (0)

1.
Health care prices. This is just basic economics. Providers charge
whatever they think consumers will pay. Consumers must judge if they
get the value they expected. Over time, though, poor quality and high
priced providers go out of business -- unless they are kept in
business by some government-sanctioned monopoly situation, such as
single-payer and other stupid schemes being set up in the latest
federal health care law.

2.
Price-sensitive choices. There is a lot assumed under this question.
Is it really true that you do NOT get what you pay for? Maybe higher
quality DOES command a higher price (why is a Toyota more expensive
than a Yugo? is there even a Yugo anymore?). Who is to decide? Can the
customer willingly pay a higher price for higher quality? Does the
insurer or that State have the right to demand higher quality at a
lower price (as they do now under Medicare, thereby driving doctors
out of the business and thereby denying people the quality service
they need)? Do patients really choose a doctor only on the basis of
cost? Does the insurer make an effort to seek out and do business with
lower cost providers? Do they make sure the quality does not suffer?
Do they measure quality the same way the customer does? Do they make
an effort to provide this information to the subscribers? Do the
subscribers really have a choice? Many plans have "preferred" and "out
of plan" rates, with a sickening habit of putting your favorite doctor
in the "out of plan" category. And government has this sickening habit
of setting up de facto monopolies, by licensing certain insurers but
not others, definitely not out-of-state ones. How do you expect to
reduce costs if you inhibit competition? Who is a better judge where
to reduce costs so as to remain competitive (or stay in business,
even), is it the guy running his business, or a government hack who
most likely has no business experience at all and most certainly has
no personal interest in the success or failure of the business or the
satisfaction of the customer?

3.
Other public plans. Whoa, horsey! What the heck is this nonsense
about government employees having their own plans? What ever happened
to "what's good for the goose is good for the gander"? Maybe if
government officials and government employees had the same choices
that they prescribe for the rest of us peons, many things would be a
whole lot better. (1.) The State has no business paying for anybody's
health care, let alone set up programs open or preferential to some
and denied to others. (2.) The State's only obligation is to prevent
crime. Otherwise it must stay out of the free market.

4.
Private plans. To begin with, there should not be a distinction; no
"public" or "private" plans. There should only be plans that people
can buy into, regardless of their employment status or who their
employer is. Government has no business setting up and paying for
separate plans for employees (and another one for welfare clients),
and employers have no business choosing and paying for plans for their
employees (again making unreasonable and unfair distinctions between
officers, full time employees and part time employees). Your house,
car and other insurance do not depend on whom you work for; why should
medical insurance? As to the details of the plans, let the free
market devise whatever scheme works. People are individuals. Their
needs vary. Their idea of what it takes to meet those needs vary.
Their resources vary. Their preferences vary. There is no "one size
fits all," or even "a few sizes fit most." Government has no right to
mandate what is in a plan and how a plan should be structured.
Government brings no more information, intelligence or good will to
the table than any business man trying to set up a viable business, or
customers trying to decide if they want to do business with one
provider or another. If some people lack the time or intelligence to
absorb the required information and make practical choices, then right
there is a business opportunity to help them with this for a small
fee. There are plenty of examples already in place; Deloitte
Consulting is one. Of course the trouble with their services is that
when they do it on behalf of the State, not the individual employees,
they are in fact imposing choices on employees as a group. What is
wrong here is that there is nothing special about health care that
should require government interference in the market, except of course
the fact that it fulfills the politician's and other power monger's
ultimate dream, the power of life and death over the entire
population.

Dave Broden (10) (10) (10) (10)

1.
Health care prices. Cost and Quality must be viewed as independent
variables. Far too often services and capabilities make (the)
statement that more money is directly proportional to cost. Well
thought out analysis suggests the opposite or definitely (that the two
are) independent. Focusing on quality and capability first will always
find a better way. If focus is on cost a different answer results

2.
Price-sensitive choices. As long as there is a quality criteria.
Obviously there has to be an incentive to go with the lower price or
higher quality. Incentives will work if value and benefits are linked.

3.
Other public plans. Tiered plans, if well structured, are incentives
to management by the individual and also provide strong cost control
opportunity. Expanding to all is a wise decision.

4.
Private plans. Many private plans do already in various forms and
types of coverage. Again, the use of well-planned incentives that can
be easily understood by the consumer and measureable by the user and
service provided will definitely add quality and control cost.

W.
D. (Bill) Hamm (0) (0) (0) (0)

1.
Health care prices. If this were true why, would we have "Cadillac
Plans" for the rich and upper Middle Class? Why are you so sadly and
ignorantly trying to make us believe cheaper health care is better
healthcare? This is just a thinly veiled attempt at window dressing on
rationed healthcare. You get to pick and choose from the best of the
best but we have to pay extra for varying "Quality" healthcare. How
stupid do you really think we are?

2.
Price-sensitive choices. Does this mean that we rural folks should
spend our day driving halfway across the state to save your ridiculous
system $15. This is the kind of efficiency transfer you are talking
about. Most of us only have one provider for miles around. Is this
part of your plan to further push us off our land?

3.
Other public plans. I strongly suspect this Government Employee group
is predominantly metro base where this may actually have some merit
because of the variety of options. Applying this logic to a state wide
population without careful examination of its effects is derilect.

4.
Private plans. We of the 62% want a healthcare system that meets the
following criteria: (1) We want a "Patient Based" proactive wellness
based system that is first and foremost concerned with what is in our
best (interests) for our health. All other considerations take a back
seat. (2) We want a system that protects our healthcare workers from
financial harm by participatory "Quality Control" with a built in
(patient included) overview system that forces all medical
professionals to participate in self-help and self-improvement
programs. This effort would be internally controlled. (3) We want a
system that does not allow the Insurance Companies to make one red
cent of profit off our health ever again. In addition to this, we do
not want to ever see any “Public Employee” controlled Socialist style
bureaucracy “bloating” costs of any such healthcare system. In short,
we have as much loathing for any scheme of Socialistic central
control, (Single Payer Healthcare), as we do for Insurance Company
greed. Does such a program exist? The answer is yes it has very
successfully since 1962 as a Co-op structure providing healthcare for
17% of what we now pay. I have spoken of this on this site before, a
Co-op structure used by the Basque Cooperative Corporations. The fact
is “White Collar Public Employees” are only concerned with swelling
their ranks at our expense, and the profit-minded Insurance Companies
and their agents only see us as a money machine, so we will never hear
about any other viable options, and especially not any better ones.
What we have now, and what this is, has nothing to do with what we
need or what is best for us or for our health. Bean counters who have
found a way to create a level of inefficiency beyond belief.

Dennis L. Johnson (10) (7.5) (10) (10)

1.
Health care prices. Health care plans for state employees should be
the same as those for all state residents, at the same available cost
tier options. Policies should be written across state lines, and there
should be a privately published national "Consumer Reports" magazine,
supported by subscriptions, to provide ratings and information
regularly for Health Care Consumers about Plans, Hospital care, and
other Health Care services. And roll back Obamacare!

2.
Price-sensitive choices. Agree but not by regulation but by
information provided as above. And roll back Obamacare!

3.
Other public plans. Should be extended to the General Public as well
so that Unionized employees will not bargain their way to a system
more costly and and more desirable than that available to the
public. And roll back Obamacare!

4.
Private plans. See question 3 And roll back Obamacare!

Bob White (10) (10) (10) (7.5)

Wayne Jennings (10) (10) (10) (7)

Paul and Ruth Hauge (9) (8) (8) (8)

Lyall Schwarzkopf (7) (9) (9) (9)

The Civic Caucusis a non-partisan,
tax-exempt educational organization. The Core participants
include persons of varying political persuasions, reflecting years of leadership in politics and
business. Click here to see a short personal background of each.